Agenda item

To present the Committee with an overview for childhood and seasonal immunisations.

Dr Melanie Smith (Director of Public Health, Brent Council) introduced the report which provided an update on childhood and seasonal immunisations in Brent. She explained that the arrangements for immunisations were national and determined by the Health and Social Care Act 2012. The Joint Committee for Vaccination and Immunisation (JCVI) gave independent recommendations on immunisations schedules, that NHSE then implemented. Dr Melanie Smith believed that the independent advice from JCVI had stood the country in good stead to have a world class immunisations programme.

In further explaining the arrangements for immunisations, Dr Melanie Smith highlighted that NHSE were responsible for the commissioning of immunisations and providers were generally GPs for both childhood and seasonal immunisations, although recent years had seen an increased role for community pharmacists in delivering immunisations programmes. The exception to that was the school-aged programme for immunisations, which was provided in schools by a specific workforce commissioned by NHSE. Within Brent, that workforce was provided by Central and North West London NHS Foundation Trust. The UK Health Security Agency (UKHSA) were responsible for providing expert advice to NHSE, in particular on outbreaks or potential outbreaks of vaccine preventable diseases such as the case recently with Polio.

At present, the Integrated Care Board’s (ICB) role around general practice was largely one of quality assurance and development, and, in time, NHSE’s responsibility for commissioning would be devolved to ICBs. There was also the newly established borough-based partnership, which did not have responsibility for immunisations but did have responsibility for addressing health inequalities and who had taken it upon themselves locally to make immunisations and addressing health inequalities within immunisations a priority. The local authority public health role for immunisations was one of independent challenge and assurance, and the Health and Wellbeing Board in Brent had recently discussed immunisations in January 2023 to assure themselves. Dr Melanie Smith summarised the discussion at that meeting, where the Board reflected, with the input of local GPs, on the significant challenges that local primary care services were facing. Local GPs had made developments and initiatives to improve access to vaccination, including weekend clinics. The Board also recognised the shortcomings in the official statistics for childhood immunisations, specifically the fact that the official statistics did not take account of deprivation or ethnicity. The Board had also discussed the variety of experiences and beliefs that communities within Brent held around immunisations, with some views informed by a historic experience of inequalities and structural racism within the provision of public services. Lastly, the Board had looked forward to an increasing flexibility in the local response to immunisations which they hoped to see as a consequence of delegation of the immunisations responsibilities from NHSE.

The Chair then invited Susan Elden (Consultant in Public Health, NHSE) to report the headline findings for Brent. Susan Elden informed the Committee that Brent had similar levels of vaccination rates to the London region, which had been impacted since the pandemic and had declining rates of immunisation. There was now an uptick in particular areas of immunisations. Areas of concern were around the MMR vaccine, where measles needed a very high coverage of immunisations to prevent outbreaks. The flu vaccination for school aged children was also quite low.

The Chair then invited comments and questions from the Committee, with the following issues raised:

The Committee noted the challenges listed in the report, and asked how NHSE and local health partners would work to address them. Tom Shakespeare (Integrated Care Partnership Director) highlighted that the Integrated Care Partnership (ICP) were very aware of the challenges in Brent and, following the Community and Wellbeing Scrutiny Task Group on GP access, there had been a lot of work done with the primary care team, GP practices, and the new clinical lead in the borough to look at what more could be done around access. As a result, a significant number of additional appointments had been released, and there had been improved access for online and telephone consultation as well. In relation to staffing, there had been a 100% increase in Additional Roles (ARR) to support GPs and the ICP were looking to use additional funding coming on stream next year to offer more appointments at individual practice level as well as hub level. A communications piece would run alongside that to ensure members of the public were aware of the offer. Councillor Nerva (Cabinet Member for Public Health and Adult Social Care) hoped that, as the Integrated Care Board (ICB) took a greater interest and role in the commissioning of immunisations, NWL as a sector would begin to drill down to locality and, where necessary, GP level, in relation to the uptake of immunisations.

The Committee had concerns that there were still members of the public who were unwilling to take children for immunisations due to fear of a relationship between autism and immunisations. They asked whether there was any work being done around that concern. Dr Melanie Smith agreed that the issue was important to highlight. National communications had taken the view that the argument had been addressed sufficiently, but officers were hearing that was not the case locally for Brent. She felt this highlighted the importance of having both good national communications but then supplementing that with very tailored messages that had generated locally from people within communities that were known and trusted. Brent had done that successfully during Covid and were now looking at repeating that type of communication, including for the linkage between MMR immunisations and autism, which had been discredited. The initial physician who put that theory forward had also since been discredited. The primary aspect of communications about immunisations was done through the NHS, which was done in a number of different language formats and through social media standardised messages, but those were less good at understanding problems and unpicking them. Susan Elden felt it was important not to be overly reductive, but there was a need to understand why certain ethnicity groups had lower uptake of immunisations, which was why the local communications and engagement piece was so important in order to understand what different communities needed.

Susan Elden highlighted that there were a number of local authority areas with persistent issues around inequalities, challenges with access, a need to understand ethnicity data and vaccine hesitancy. On a regional level, it had been found that ethnicity data at GP level was often ticked as ‘unknown’, so a project to improve ethnicity data collection had been piloted in a few areas and it was hoped this would be rolled out wider so that GPs could get better at collecting ethnicity data.  Dr M C Patel highlighted that he would be interested in learning the comparative data of the immunisations take-up of different ethnicity groups compared to their countries of origin, in order to learn from them if they were reaching higher figures.

Committee members observed that there may be cultural and religious reasons that may make parents reluctant to bring their children forward for immunisations. They queried how successful Brent had been in reassuring vaccine hesitant groups and whether there had been any changes in uptake following Brent interventions. Dr Melanie Smith advised that, in her experience, improving vaccine uptake could be done, but there was no one intervention that made a difference because the interventions needed to be tailored to different communities, and a range of different offers needed to be made available. As such, she felt that Brent had made change but not at scale, and the only way it would change at scale would be to continue to be targeted but at a greater scale.

The Committee asked what awareness was being raised for HPV immunisations. Dr Melanie Smith felt that there had not been enough and a chance had been missed when the vaccine was introduced for boys as well as girls. She highlighted the importance of empowering young people to make their own informed decisions regarding immunisations, as this was a vaccination that had been proven to prevent cancer. In raising awareness of that, she thought it would be useful for young people to lobby the system to make it easier for them to get vaccinated. In considering the HPV vaccine, members highlighted that the uptake in Brent was slightly above the London average, and asked why that was and what learning could be taken from that for other immunisations programmes. Dr Melanie Smith advised the Committee that school-aged immunisations had the advantage of being delivered to large numbers of children very easily. Although she agreed that Brent had done very well, she wanted to be certain that every young person in Brent had received an offer and a repeat offer and been given a chance to make an informed decision.

The Committee asked what work was being done in Brent to ensure children of non-English speaking families did not slip through the gap to access the vaccinations they needed, including amongst emerging communities. Dr Melanie Smith advised the Committee that the approach was 2-fold. The first was ensuring any standard communications were available in community languages, and she commended NHSE and the London Immunisations Board for the work they had done to ensure that. For emerging communities, producing standard information in a suitable language did not necessarily address the specific issues those communities had, so it was about ensuring general information was accessible but also listening to emerging communities to understand their particular issues and tailoring communications to that.

The Chair thanked those present for their contributions and brought the discussion to an end. He invited the Committee to make recommendations, with the following RESOLVED:

i)              To recommend that communications and engagement with different communities in Brent is targeted but done at a greater scale to improve the health outcomes of vaccine hesitant and apathetic groups.

ii)             To recommend that a collaborative approach between public health and Brent Health Matters is developed to increase vaccination uptake, including for HPV immunisations.

In addition to the recommendations, a number of information requests were raised throughout the discussion, recorded as follows:

i)              To receive a breakdown of the number of childhood vaccinations by GP practice, to provide a more localised understanding of vaccination uptake across Brent’s primary care system, and to inform the NHS’s approach to improving vaccination uptake.